Cancer is a class of diseases characterized by uncontrolled cell division and the ability to invade other tissues, either by direct growth into adjacent tissues or by migration of cells to distant sites. Cancer can arise from virtually any cell, organ, or any part of the human body.  The corner stone to cancer management in the developed world is cancer prevention through awareness education, screening, early detection and treatment. Cancer awareness education is gravely lacking in most developing parts of the world, Africa inclusive. Cancer in Africa is characterized by late stage presentation when treatment is less effective, expensive, and most patients experience intense pain.

In developed countries where public campaign and screening has greatly improved, death rate from both cancers has greatly declined. Cancer awareness and prevention programs are conducted all over countries as the United States of America by government organizations and non profit organizations. Health promotion and disease prevention is being propagated.  This has made a world of difference on incidence, mortality and morbidity due to cancer in the populace. Death from cervical cancer is 100 percent preventable. Breast and cervical cancer are both curable if diagnosed early (ACS, 2005).  According to a report by PAHO (2005), incidence and mortality rates from cervical cancer have declined steeply in North America, to below 10 per 100,000 females in both Canada and the United States;  rates in most Latin American and Caribbean countries are higher than 20 cases per 100,000 and are surpassed only by rates found in Africa

Pap smear has transformed cervical cancer from a leading killer to a rare disease in the United States (Easton, 2005). With the introduction of Pap smears forty years ago, cervical cancer incidence in U.S had fallen by 75% (Katz & Wright, 2006). Nigeria and other developing countries have very limited resources and infrastructure to run organized screening programs.  These countries therefore bear the brunt of the disease.

Cancer Prevention
This can be divided into primary, secondary, and tertiary prevention.

Primary Prevention
The goal of primary prevention is to stop cancer onset and includes:
o   Education about cancer to create awareness.
o   Life Style changes (Smoking, alcohol, Exercise, diet,  Sexual behavior)
o   Immunization (Hepatitis and HPV vaccines)
o   Prevent Infections implicated in cancer
o   Human Papillomavirus Virus (HPV) infection is a necessary event for subsequent cervix
    cancer (vaccine-conferred immunity results in a marked decrease in precancerous lesions).
o   Epstein-Barr virus has been associated with Burkitt’s lymphoma.
o   Helicobacter pylori with gastric cancer
o   Hepatitis B and or C virus associated with liver Cancer.

Nutrition, Lifestyle changes & Cancer Prevention
o   Alcohol consumption (associated with increased risk of oral, esophageal, breast and other cancers).
o   Diet low in fiber and colon/gastric cancers (Eat more fruits and vegetables, upto 6 servings/day).
o   Diet rich in fat associated with Colon & breast.
o   Physical inactivity (associated with increased risk of colon, breast, and possibly other cancers).
o   Obesity (associated with colon, breast, endometrial, and possibly other cancers).
o   Certain sexual and reproductive practices,
o   The use of exogenous estrogens, exposure to ionizing radiation, and ultraviolet radiation, certain occupational and chemical exposures, and infectious agents.
 
Secondary Prevention
The goal is to slow down cancer and includes:
o   Education
o   Screening for Cancer
o   Self-Breast Examination/Testicular self examination
o   Routine Physicals
o   Mammography
o   Pap smear/ copolscopy
o   Digital Rectal Examination/Fecal occult blood test
o   Prostate Specific Antigen (PSA for prostate cancer) and H. Pylori testing
o   Colonoscopy
 
Secondary prevention modalities
o   Fecal occult blood testing has been demonstrated to reduce both colon cancer incidence and mortality.
o   Screening for colon cancer by colonoscopy and sigmoidoscopy reduce both colon cancer incidence and mortality through the detection and removal of precancerous polyps.
o   Cervical cytology testing (using the Pap smear) leads to the identification and excision of precancerous lesions.
 
Tertiary Prevention
This includes modalities as:
o   Diagnostic procedures e.g. pathology and staging
o   Treatment (Medical, surgical and radiation therapy)
o   Research (Within the country and international collaborations)
o   Training (Residents, fellows, mid-level providers, nurses, CME for all categories of health care personnel in cancer management).

Preventable Cancers

Breast cancer
o   Regular breast self-examination monthly
o   Clinical Breast examination of the breast annually.

Cervical
o   Early detection by “Pap smear”
o   Visual inspection technique with acetic acid or Lugol’s iodine.
o   Vaccines against Human Papilloma Virus (HPV).
 
Skin
o   Avoid sun light
o   Use of sun screen
o   Routine Physical
o   Biopsy of suspicious lesions.

Colorectal Cancer
o   Diet (fruits, vegetables & high fiber)
o   Screening with colonoscopy with removal of precancerous polyps.
o   Exercise